The airway management in general anesthesia,
follow ASA Difficult Airway Guideline.
Moderate/deep sedation - - use CO2 monitoring General anesthesia + secure airway > deep sedation +no airway Be extubated when fully awake in the upright position & reversal of
RISK =4 ANY FACILITY SHOULD HAVE 1 EMERGENCY DIFFICULT AIRWAY EQUIPMENT 2 RESP CARE RX=
NEBULIZES,CPAP,VENTILATORS 3 PORTABLE CHEST X-RAY & ECG 4 CLINICAL LAB FOR ABGS,ELECTROLYTES,
POR: postoperative opioid requirement No POR, Low Dose Oral POR ,Moderate Dose Oral POR And a High Dose of POR (0 score >>3score)
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PERIOPERATIVE MANAGEMENT OF OSA： FACILITY OUTPATIENT & INPATIENT
Severe(3)：obese morbidly, snore all night, observed apneas & arousals frequently, falls asleep during most of the quiet times during the day.
Moderate（2）：between these two extremes
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I of A/：
0：superficial surgery + local anesthesia or peripheral nerve block + not sedation 1: superficial surgery + local anesthesia or peripheral nerve block + moderate sedation 2: superficial surgery + general anesthesia 3: major cavitary or airway surgery + general anesthesia
neuromuscular blockade. Spinal/Epidural Anesthesia in peripheral surgery> GA& /or Opioids
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CPAP or NIPPV should be administered as soon as possible after surgery to patients with OSA who were receiving it preoperatively.
Continuous bedside SpO2 without continuous observation does not provide the same level of safety.
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1、Is there is a history or observation of apnea or snoring with hypopnea (sleep disordered breathing SDB)
2、Is there a history or observation of arousal from sleep(extremity movement,turning, vocalization发声, snorting鼻息声 )
3、Is there a history or observation of daytime somnolence (easily falls asleep during the quiet times of the day)
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Mild(1): obese, snores most of the time they sleep, not observed apnea or arousals, not falls asleep easily daytime.
HGB/HCT
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PERIOPERATIVE MANAGEMENT OF OSA PATIENTS:CONSULTANTS AGREEMENTS: PREOPERATIVE & INTRAOPERATIVE
Preoperative preparation with cpap or bipap improves physical status.
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CAUSES OF OSA: OBESITY BMI ≥ 35 MICROGNATHIA & RETROGNATHIA NECK ≥ 17” (MEN), 16” (WOMEN) NASAL OBSTRUCTION BIG TONSILS/LARGE TONGUE